Transurethral resection of the Prostate Gland (TURP)

Bladder outflow obstruction from benign prostate enlargement (“prostatism”) is common in middle-aged and older men. It frequently causes bothersome symptoms of poor flow, delay in starting voiding, feeling of incomplete emptying, frequency, urgency and night-time voiding.

Left untreated, a third of patients worsen, a third remain stable, and a third improve. A minority of patients block completely and require temporary catheterisation.

Not every man will want treatment for “prostatism”. In those who find the symptoms bothersome however, the options are medication or surgery. Surgery is significantly more effective than medication, 85% of patients having an excellent outcome and marked improvement in urinary symptoms long term.

It is most commonly performed telescopically, shaving the overgrown central part of the prostate to relieve the obstruction (TURP). This is associated with less pain and superior recovery when compared to open surgical procedures, allowing earlier return to normal function and shorter hospital stay.

Pre-operatively:

• urine sample to the laboratory 1 week prior to surgery
• discontinue aspirin 1 week prior, other medications may need to be stopped
• nil by mouth from midnight, enema evening prior to surgery

Post-operatively – early:

• day 1: diet, reinstate usual medications, out of bed into chair, stop bladder irrigation, maintain a high fluid intake (2 litres daily) for 2 weeks
• day 2: remove urethral catheter and assess voiding, then home
• some blood in the urine commonly occurs 10-14 days post-operation; this settles spontaneously and is rarely problematic
• avoid heavy lifting for 6 weeks; thereafter resume full normal activity including sexual intercourse

Although most cases proceed without particular difficulty and have excellent outcomes, surgical complications occur in 5% of patients overall.

• 5% of patients are unable to void initially and require re-catheterisation for 1-2 weeks. Following removal of the catheter, most patients experience burning with voiding, frequency, urgency, night-time voiding and some incontinence. These settle rapidly and can be improved by pelvic floor exercises. Many patients will wear a pad for a few days to protect their clothing.
• Some 30% of patients will have persisting bothersome urinary symptoms, the majority of whom improve over time, but the full benefit only being realised after 6-9 months.
• All patients experience reduced or dry ejaculation. Whilst this generally results in infertility, it is unreliable as a means of contraception.
• Potency is not affected overall: studies show as many patients report improved erections as report worsened erectile function. Similar changes in erectile function are seen following certain orthopaedic procedures. Patients should resume normal sexual activity, confident that it is safe to do so, 3-4 weeks after surgery, accepting that the reduced ejaculation may change the sensation of orgasm.
• Benign prostate enlargement is unrelated to prostate cancer. TURP removes only the central portion of the prostate and does not protect against future development of cancer in the prostate remnant.

The list below details complications recognised as common or serious, but this does not include the rare and extraordinary.

This fact sheet complements the discussion during your consultation, which will apply your individual circumstances to the above facts.